Wide vs. Narrow Heeled Shoes and Knee Osteoarthritis:

February 11, 2003 -- Women who love to wear high heels may want to reconsider their preferred footwear, says Dr. D. Casey Kerrigan, chair of U.Va.’s Department of Physical Medicine and Rehabilitation. Her research suggests that high-heel shoes may be a primary reason why osteoarthritis of the knee is twice as common in women as in men. Her findings are particularly relevant considering that knee osteoarthritis can be as disabling as any cardiovascular disease except stroke, according to the Arthritis Foundation.

KNEE OSTEOARTHRITIS:
Osteoarthritis, sometimes called wear-and-tear arthritis, is caused by degeneration of cartilage in the joint. As cartilage breaks down, bones can rub together, resulting in mild to severe pain and loss of motion in the joint. Knee osteoarthritis affects most people to a degree as they age. Treatment is limited, however, to symptom management except in the severest cases, in which knee replacement may be recommended. "Knee osteoarthritis causes more disability with respect to mobility than any other singular disease in the elderly," points out Dr. Kerrigan. Limited mobility increases a person’s risk for cardiovascular disease, obesity and diabetes and is linked to anxiety and depression. "If you get arthritis in the knee, it’s just a downward spiral," she adds.

HIGH HEEL RESEARCH:
With prevention of knee osteoarthritis in mind, Dr. Kerrigan and colleagues sought to explore footwear and its affects on the knees. "A lot of research has looked at the effect of shoes on the foot, but we wanted to see if there are effects further up the chain," explains Dr. Kerrigan. Initial research performed by Dr. Kerrigan and colleagues at Harvard Medical School and Boston’s Spalding Rehabilitation Hospital revealed that walking in 2_-inch-heel shoes increases strain on the parts of the knee that are most vulnerable to osteoarthritis by 23 percent compared to walking barefoot. "All heels are to blame—not just the narrow stilettos," notes Dr. Kerrigan, explaining how subsequent research comparing narrow heels with wide, "comfortable" heels demonstrated even greater stress with the wide-heel shoes. The reason for this, Dr. Kerrigan believes, is that women feel more comfortable in wide-heel vs. narrow-heel shoes and thus place greater force through the heel than otherwise, which increases the stress through the knee even more. Dr. Kerrigan and her colleagues have also shown that strain on the knee joint when walking barefoot is no different for men and women, eliminating any question of knee stress resulting from gender differences. "Before our studies on high heels, obesity was probably the only risk factor for knee osteoarthritis thought to be preventable," shares Dr. Kerrigan, whose research has received a great deal of attention from both the medical community and the popular press. In fact, Newsweek, The New York Times, and ABC-TV’s 20/20 covered the studies’ findings.

HOW HIGH IS TOO HIGH?
Ultimately, Dr. Kerrigan would like her research to lead to improved shoe design and answer specific questions such as "How high is too high?" or "What about wearing heels only for special occasions?" But she suspects wearing high heels is a lot like smoking cigarettes. Says Dr. Kerrigan, who, incidentally, never wears heels: "When smoking research was in its infancy, people wanted to know how much is too much. As for wearing high heels, probably the more you wear heels, the more likely you’ll develop arthritis. My advice is don’t wear heels."
This article was published in UVa Top News Daily, 2003 News Releases.